Does reducing exposure to Mycobacteria ( NTM) work?

Posted by cholash @cholash, 1 day ago

Ok, I’m sure this will open up a whole hornets nest , but here we go….

I was at a pulmonologist appt yesterday , at a Recognized Bronchiectasis & NTM Center Of Excellence . This was my second appt there.

Both appts when I asked about the risk with MAC in water , etc, the pulmonologist stated there’s no evidence that changing shower heads , drinking water , etc , will keep someone from getting MAC. *She said “ it’s not scientifically proven” . She’s had patients that do all those things and still fight MAC. She’s also had patients that did none of it and they either didn’t get MAC, or were able to get rid of the MAC with standards treatments , and they continued to do fine without starting all the MAC preventions .

Lastly, she said they ( researchers ) still don’t know why some people get MAC and others never do , regardless of any preventative measures . Therefore , if you’re one of the ones to never get MAC, you could be doing all the MAC lowering risk measures for nothing , as you may have not become infected anyway .
She did recommend I wear a mask if gardening.
.
This is all new to me. I had a MAC sighting in the first culture I had there last Dec , but this last one it was negative .

Again , she’s at a Center Of Excellence, so this was all surprising to me . Apparently there’s not consensus in the medical community regarding this topic. Sure makes it hard to know how to navigate it all….

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Profile picture for jnmy @jnmy

@cholash What an interesting post and responses to it.
There is a fairly wide range of opinions even in the scientific community about how to avoid or who might be susceptible to NTMs and MAC.

Is there research that shows that ‘never smokers’ are less likely to have MAC? That might make some sense, but there needs to be scientific studies. Never smokers may have also been exposed to second hand smoke.

Exposure to soil and the peat moss in potting soil is something I try to avoid by masking or moistening the soil and working in non windy environments. I don’t swim in indoor pools. I use bottled spring water or a Lifestraw bottle when travelling.

It would be hugely beneficial if we could easily test water for NTM. With all the new technologies available, this might happen?

The pulmonologist’s statement that some people might be inherently more susceptible to these diseases should be explored if there isn’t ongoing research now.

Is there a biological cause or even a precipitous event in someone’s life that coupled with other factors causes them to develop MAC?

Thanks for posting.

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@jnmy And I wonder if getting NTM or not (with BE) has to do with adherence to airway clearance. Many posts I read here, but not all, are from those who were recently diagnosed with BE and MAC at the same time so they did not know about airway clearance. Those diagnosed with BE only are instructed to do airway clearance twice day, and as a result ward off MAC/NTM.

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Hi, the mysteries of this condition baffle me. To make a long story short, I was prescribed nebulizing 2 x a day, flutter valve and azyithromyacin every other day. I do not have MAC. I switched my care to a bronchiecstatis clinic in Rochester, NY. I had a pulmonary function test (I was happy to finally get an PFT) and was told I had asthma along with mild bronchiecstatis. I was taken off the azyithromyacin (happy about that, as I was worried about antibiotic resistance) and the nebulizer and flutter valve. I was prescribed an Advair puffer for asthma. I asked about mask wearing for gardening and was told it was unnecessary. The other, younger doctor, however, surreptitiously indicated mask wearing while gardening is a good idea. I was also wondering about GERD as I have been getting pain under my ribs, which has woken me up at night (pain not due to coughing). Recently, my chest heaviness /burning has returned. I can never tell if I’m having a flare and need antibiotics (no fever and I don’t produce enough sputum to expel). I fear I’m turning into a neurotic hypochondriac! My previous pulmonologist’s nurse told me I didn’t look sick , when I felt very sick and had to beg for antibiotics. My next appointment with the bronchiecstatis specialty clinic is in a few weeks via telemedicine, due to distance.

Any advice, thoughts are very welcome. Thanks for allowing me to vent:)

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Profile picture for kahkej @kahkej

Hi, the mysteries of this condition baffle me. To make a long story short, I was prescribed nebulizing 2 x a day, flutter valve and azyithromyacin every other day. I do not have MAC. I switched my care to a bronchiecstatis clinic in Rochester, NY. I had a pulmonary function test (I was happy to finally get an PFT) and was told I had asthma along with mild bronchiecstatis. I was taken off the azyithromyacin (happy about that, as I was worried about antibiotic resistance) and the nebulizer and flutter valve. I was prescribed an Advair puffer for asthma. I asked about mask wearing for gardening and was told it was unnecessary. The other, younger doctor, however, surreptitiously indicated mask wearing while gardening is a good idea. I was also wondering about GERD as I have been getting pain under my ribs, which has woken me up at night (pain not due to coughing). Recently, my chest heaviness /burning has returned. I can never tell if I’m having a flare and need antibiotics (no fever and I don’t produce enough sputum to expel). I fear I’m turning into a neurotic hypochondriac! My previous pulmonologist’s nurse told me I didn’t look sick , when I felt very sick and had to beg for antibiotics. My next appointment with the bronchiecstatis specialty clinic is in a few weeks via telemedicine, due to distance.

Any advice, thoughts are very welcome. Thanks for allowing me to vent:)

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@kahkej What percentage of saline do you nebulize? When were you diagnosed? Regarding burning in chest sounds like some variation of GERD. Trying a H2 blocker (Famotidine, aka Pepcid, Zantac 360) might help. Also stopping all food and drink 3 hours before sleep helps as does sleeping at an upright angle, for instance, on a wedge. Certain foods can trigger GERD and burning in chest. For me it's onions, a lot of garlic, and dark chocolate if I overdo.

This page describes symptoms of an exacerbation.
https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Exacerbations

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Profile picture for jnmy @jnmy

@cholash What an interesting post and responses to it.
There is a fairly wide range of opinions even in the scientific community about how to avoid or who might be susceptible to NTMs and MAC.

Is there research that shows that ‘never smokers’ are less likely to have MAC? That might make some sense, but there needs to be scientific studies. Never smokers may have also been exposed to second hand smoke.

Exposure to soil and the peat moss in potting soil is something I try to avoid by masking or moistening the soil and working in non windy environments. I don’t swim in indoor pools. I use bottled spring water or a Lifestraw bottle when travelling.

It would be hugely beneficial if we could easily test water for NTM. With all the new technologies available, this might happen?

The pulmonologist’s statement that some people might be inherently more susceptible to these diseases should be explored if there isn’t ongoing research now.

Is there a biological cause or even a precipitous event in someone’s life that coupled with other factors causes them to develop MAC?

Thanks for posting.

Jump to this post

@jnmy it’s my understanding that NTM is in most water . It’s just not a problem for the average person . “Is there a biological cause ? “ At this point, I don’t know if it’s been studied . According to my NTM specialist , she’s had a lot of BE patients that never get MAC, and they don’t practice risk prevention . I think “ predisposition “, and what exactly that is, may be the million dollar question .

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Profile picture for scoop @scoop

@kahkej What percentage of saline do you nebulize? When were you diagnosed? Regarding burning in chest sounds like some variation of GERD. Trying a H2 blocker (Famotidine, aka Pepcid, Zantac 360) might help. Also stopping all food and drink 3 hours before sleep helps as does sleeping at an upright angle, for instance, on a wedge. Certain foods can trigger GERD and burning in chest. For me it's onions, a lot of garlic, and dark chocolate if I overdo.

This page describes symptoms of an exacerbation.
https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Exacerbations

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@scoop Thank you for the suggestions. Much appreciated. I am not currently nebulizing. The bronchiecstatis clinic pulmonologist had me stop nebulizing and begin the Advair puffer.

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Profile picture for blm1007blm1007 @blm1007blm1007

@scoop @rockinkranch @bayarea58 @sueinmn @cholash
So many say "Living My Life".
I can't say I am.
Yes I feel well, MAC Intercellular down to nearly nothing without the antibiotics, light exercise before nebulizing, postural drainage with percussion before and after, mask 99% percent of the time, hot water tank temp. raised, shower head allowed to dry out before another shower, etc. etc. etc. and eat healthy.
However, I for various reasons including the need to clear my mucus after anything I swallow and then wanting to avoid Covid, Flu, Cold, RSV, Pneumonia etc. I avoid, 95% of the time, being out and about in situations where there will be a large numbers of people in close contact. Why,.......because I am more concerned with avoiding all other types of illnesses as outlined...for fear of a hospital requirement, stay.
With living alone there is also that time factor. Having to do all we need to do for our health and then having to do all for ones self and keep up a home...even if you hire some things out it's hard to get it all done and then a good nights rest.
Maybe I need a good talking to. I'm not depressed, just disappointed with the loss of... not.... having to consider so many things that one didn't have to consider before.
I'm trying to find my way out of that mental state and hopefully I will.
So glad I could vent and know there is an understanding by those listening and reading this.
What a journey we are put on.
Barbara

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@blm1007blm1007 I’m sure living alone adds a whole different complexity to managing this disease. I’m not there yet, but I’m certain that one thing could change my perspective on risk … with anything . Warm wishes for you to have clarity and peace with whatever you decide .

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Profile picture for cholash @cholash

@jnmy it’s my understanding that NTM is in most water . It’s just not a problem for the average person . “Is there a biological cause ? “ At this point, I don’t know if it’s been studied . According to my NTM specialist , she’s had a lot of BE patients that never get MAC, and they don’t practice risk prevention . I think “ predisposition “, and what exactly that is, may be the million dollar question .

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@cholash Yes, after I posted it I thought that too. NTM is in water, soil, and in the air we breathe. I agree, the predisposition, is the million dollar question.
Are there studies that demonstrate that certain other factors such as Gerd, Asthma, other lung disorders, COPD, maybe smoking etc make it somehow more likely to get infected with NTMs.

Do the structure / damage in the lungs and presence of earlier specific infections play a role? So many questions.

REPLY
Profile picture for jnmy @jnmy

@cholash Yes, after I posted it I thought that too. NTM is in water, soil, and in the air we breathe. I agree, the predisposition, is the million dollar question.
Are there studies that demonstrate that certain other factors such as Gerd, Asthma, other lung disorders, COPD, maybe smoking etc make it somehow more likely to get infected with NTMs.

Do the structure / damage in the lungs and presence of earlier specific infections play a role? So many questions.

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@jnmy all great questions and above my pay grade. Maybe others have seen studies?

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Profile picture for cholash @cholash

@sueinmn I’m so glad you have been able to keep yourself well for so long! Thanks so much for sharing yours & your doctor’s experience . To clarify , the masking in airports & crowds is for other transmissions , but not MAC, correct ? Do you mask the entire flight ? I have a pilot friend who claims once in air , the HEPA filters take over . That’s what she was taught with AA. She wears a mask until at a good flying altitude , removes, then puts back on for the descent and until off the plane .

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@cholash Yes, masking helps with most respiratory illnesses, even MAC, I believe. But for me, every respiratory illness raises the real possibility of an exacerbation, which can cause weeks of poor health, and especially, set off my coughing again.
I cannot accept that 200+ people in a crowded waiting area and jetway, then in a long skinny tube, breathing, coughing, and sneezing, are not a risk - I keep my mask on except when eating or drinking. Besides, we don't always know how well the ventilation system is working. I flew thousands of miles last fall, including 4 flights in 5 days, and managed to not catch anything. Back in my working days, when I flew almost weekly, I caught a cold or other "bug" on about every third or fourth flight - and that was years before my Bronchiectasis was diagnosed.

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Profile picture for jnmy @jnmy

@cholash Yes, after I posted it I thought that too. NTM is in water, soil, and in the air we breathe. I agree, the predisposition, is the million dollar question.
Are there studies that demonstrate that certain other factors such as Gerd, Asthma, other lung disorders, COPD, maybe smoking etc make it somehow more likely to get infected with NTMs.

Do the structure / damage in the lungs and presence of earlier specific infections play a role? So many questions.

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@jnmy & @cholash Wow, predisposition is a great question, one I have been thinking about lately.
Here is a recent paper (I'm reading it now) on just that issue -
https://www.frontiersin.org/journals/tuberculosis/articles/10.3389/ftubr.2025.1735568/full
Do you want to read it too and discuss further (looks lots of good reference studies linked to it)?

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